A new survey has found that among a national sample of parents, nearly half save leftover antibiotics prescribed for their children rather than dispose of them. And nearly three-quarters of those parents give the leftover antibiotics to someone else without consulting a doctor.

The findings are from an abstract to be presented today at the annual conference of the American Academy of Pediatrics.

Tamara Kahane, a medical student at New York University Medical School and one of the authors of the abstract, said the idea for the survey was hatched when she and her colleagues at a developmental and behavioral pediatrics office noticed something interesting: a lot of patients were saying that they had already taken antibiotics to "self-treat" illnesses, without any prior medical consultation. A subsequent review of parenting blogs and advice websites revealed a similar trend.

"Many parents were in fact encouraging one other to take antibiotics as a precaution at the first sign of any type of infection, without knowing if antibiotics were the appropriate treatment," Kahane told CIDRAP News. "That made us much more interested in this topic."

Antibiotic diversion

In the survey, 454 of 496 parents said that they often have leftover antibiotics from a previous prescription given to one their children, and 219 (48.2%) reported saving the antibiotics instead of disposing of them. Of the parents who saved their antibiotics, 159 (72.6%) stated that they had subsequently diverted those antibiotics for others to use.

Survey participants most commonly reported sharing the antibiotics with siblings of the child who received the prescription, but they also reported taking the antibiotics themselves and giving them to children and adults outside the family. Although the focus of the survey was on antibiotics prescribed for children, 16% of participants also reported giving their children antibiotics initially prescribed for adults.

Kahane said the most common reason given by parents for sharing antibiotics—whether within or outside the family—was that they thought the symptoms the recipient was experiencing were very similar to the symptoms for which the antibiotic was originally prescribed.

"I think it really illustrates a lack of understanding regarding what types of infections necessitate antibiotic use, and that they aren't a cure-all for any type of childhood illness," Kahane said. She also said it indicates a lack of awareness about possible side effects or adverse events associated with antibiotics.

Furthermore, the findings suggest that parents either don't understand, or don't appreciate, that sharing leftover antibiotic can promote antibiotic resistance. "Parents may find that hard to conceptualize on their own, because they don't think it affects them or their children," she said.

Survey participants also said they wanted to save money and avoid another doctor's visit. Kahane said that's an issue that she and her colleagues will delve further into in future surveys.

Antibiotic diversion was most common with liquid antibiotics and drops, with 80.4% and 73.8% of parents whose children had been prescribed these formulations saying they shared the medications with others. Diversion was less common with antibiotic creams (69.7%) and tablets (55.6%).

When survey participants were asked if their healthcare providers had discussed disposal of leftover antibiotics, 57.3% reported that they hadn't.

Sharing medication a common problem

Jonathan Zipkin, MD, associate medical director with Northwell Health - GoHealth Urgent Care in New York and a Fellow of the American Academy of Pediatrics, said the findings of the survey are not surprising. He noted that previous studies have investigated the phenomenon of leftover antibiotics, with one meta-analysis finding that more than 25% of patients retain antibiotics for future use.

He also sees it first-hand.

"In my own anecdotal experience, I unfortunately hear of this practice occurring in a minority of patients regularly," said Zipkin, who was not involved with the study. "A large portion of this practice…comes from misunderstanding of the 'right drug for the right bug' specific mechanism of antibiotics, and the negative impact of antibiotic resistance."

But he added that diverting medications is not novel to antibiotics.

"Research has clearly documented that patients save a variety of unused medications," Zipkin said. "Dialogue on the topic generally focuses on the inertia barrier it takes to properly dispose of medications, as well as the value that patients place on obtaining them in the first place.

"After all, the doctor's visit and prescription cost time and money," he added.

Kahane said she thinks the widespread trend of patients sharing medications like stimulants and analgesics certainly plays a role.

"Living in a world where medications are easily transferred from one person to another may also serve as an encouragement to parents to share antibiotics," she said.

Kahane said she and her co-authors are looking at the best ways to communicate to parents the dangers of sharing leftover antibiotics, emphasizing not just the individual dangers but the role that it can play in promoting antibiotic resistance.